A perspective of contemporary cataract surgery: the most common surgical procedure in the world

Abstract

Cataract is the most common, reversible cause of visual impairment and blindness in the world. Cataract surgery in primitive form has been around for millennia but the last 50 years have witnessed a monumental revolution in cataract surgery making it the most common, and one of the most successful, operations world-wide. Major advances have included the development of phacoemulsification techniques, refinement of small incision approaches, foldable and injectable specialised intraocular lenses (IOLs), day-case local anaesthetic approaches and a better understanding of risks and benefits. Clinicians and scientists in New Zealand / Aotearoa have contributed significantly to the global knowledge of cataract surgery, including aspects of indications for surgery, assessment and use of specialised IOLs including aspheric, toric and secondary IOLs, effect of surgical techniques on corneal structure and performance, training of cataract surgeons, intraoperative and post-operative complications, strategies to minimise complications, and visual outcomes following phacoemulsification surgery. These studies also reveal disparities in health care, with the indigenous Māori population demonstrating more advanced cataract at an earlier age, associated with greater risk of intra-operative complications, yet accessing cataract services disproportionally less. This review highlights key research contributions from a New Zealand perspective, in the light of contemporary knowledge and practice.